Escherichia coli (E.

coli)

Etiology
Escherichia coli (E. coli) infections

 Escherichia coli is the most common cause of health care–associated infections, it is also the leading cause of
community-acquired urinary tract infections, and cause of nosocomial bacteremia from a GI or genitourinary
source (e.g. neonatal meningitis & intestinal disease)

Characteristics

 E. coli cells are bacillus (rod-shaped) and typically occur individually and in large clumps.
 The average size of the rod is 1.1 to 1.5 µm wide by 2.0 to 6.0 µm long.
 Escherichia organisms are gram-negative bacilli that exist singly or in pairs.
• Gram stain is a differential technique that is commonly used for the purposes of classifying bacteria.
• Being Gram-negative bacteria, E. coli have an additional outer membrane that is composed of
phospholipids and lipopolysaccharides. The presence lipopolysaccharides on the outer membrane of
bacteria gives it an overall negative charge to the cell wall. Because of these properties, E. coli does
not retain crystal violet during the Gram staining process.

(light microscopy)

 E coli is facultative anaerobic(it is able to grow in both aerobic and anaerobic environments) with a type of
metabolism that is both fermentative( Under anaerobic conditions and in the absence of alternative electron
acceptors Escherichia coli converts sugars to a mixture of products by fermentation. The major soluble products
are acetate, ethanol, acetate and formate with smaller amounts of succinate.)and respiratory.
  They are either non-motile or motile by peritrichous flagella.
 E coli is a major facultative inhabitant of the large intestine.

Note: it grows well on non-selective media, forming smooth colorless colonies 2-3 mm in diameter in 18h on
nutrient agar at temperature of 15-45 oc

Mode of transmission

• E. coli is transmitted to humans primarily through fecal-oral spread between consumption of contaminated water or
foods such as raw or undercooked ground meat products, raw milk, and contaminated raw vegetables and sprouts.

 can be transmitted through the inhalation of dust particles and is particularly common among infants and young
children due to their unrefined hygienic practices.

Note: That can cause severe foodborne disease.

Epidemiology

Frequency

 United States – (E coli is the leading cause of both community-acquired and nosocomial UTI.)
 Tropical countries (international)
 The estimated incidence rate of E. coli bacteremia was 48 per 100 000 person-years, but this increased
considerably with age: rates per 100 000 person-years were >100 in 55-to-75-year-olds and >300 in 75-to-85-
year-olds.

Symptoms of intestinal infection due to E. coli

Symptoms of intestinal infection generally begin between 1 and 10 days after you’ve been infected with E.
coli. This is known as the incubation period. Once symptoms appear, they usually last around 5 to 10 days.
Symptoms can include:
1. abdominal cramping
2. sudden, severe watery diarrhea that may change to bloody stools
3. gas
4. loss of appetite or nausea
5. vomiting (uncommon)
6. fatigue
7. fever
Symptoms of a severe E. coli infection may include:
1. bloody urine
2. decreased urine output
3. pale skin
4. bruising
5. dehydration

Pathophysiology
E. coli is a common intestinal bacterium that falls midway between overt pathogens and opportunistic organisms in
terms of pathogenic categorization.

 Acute bacterial meningitis (The vast majority of neonatal meningitis cases)

 Collection of sample: CSF
 Pneumonia (E coli pneumonia may also result from microaspiration of upper airway secretions that
have been previously colonized with this organism in severely ill patients; hence, it is a cause of
nosocomial pneumonia.)
 Collection of sample: sputum
 Intra-abdominal infections (E coli intra-abdominal infections often result from a perforated viscus
(eg, appendix)). or may be associated with intra-abdominal abscess, cholecystitis, and ascending
cholangitis.
 Collection of sample: pus or infected fluid (surrounded by inflamed tissues inside the belly)
 Enteric infections (As a cause of enteric infections, 6 different mechanisms of action of 6 different
varieties of E coli have been reported.)
1) Enterotoxigenic E coli (ETEC) is a cause of traveler's diarrhea.
2) Enteropathogenic E coli (EPEC) is a cause of childhood diarrhea.
3) Enteroinvasive E coli (EIEC) causes a Shigella -like dysentery.
4) Enterohemorrhagic E coli (EHEC) causes hemorrhagic colitis or hemolytic-uremic syndrome
(HUS).
5) Enteroaggregative E coli (EAggEC) is primarily associated with persistent diarrhea in children in
developing countries,
6) Enteroadherent E coli (EAEC) is a cause of childhood diarrhea and traveler's diarrhea in Mexico
and North Africa.
 Collection of sample: stool

Note: ETEC, EPEC, EAggEC, and EAEC colonize the small bowel, and EIEC and EHEC preferentially colonize the large bowel
prior to causing diarrhea.

o Shiga toxin–producing E coli (STEC) is among the most common causes of foodborne diseases. This organism is
responsible for several GI illnesses, including non-bloody and bloody diarrhea.

 Urinary tract infections (urinary tract is the most common site of E coli infection)
o more than 90% of all uncomplicated UTIs are caused by E coli infection. The recurrence rate after a first
E coli infection is 44% over 12 months. E coli UTIs are caused by uropathogenic strains of E coli.
o usually from stool that migrates into the urethra.
 Collection of sample: urine

Laboratory Diagnosis
Colonial Appearance

E. coli colony

 is off-white or beige in color with a shiny texture.

 It often looks like mucus or a cloudy film over the whole surface of the plate.
 An E. coli colony is slightly raised and has an entire, fixed margin and a steady growth pattern, creating concentric
growth rings in the colony while Older colonies often have a darker center.
  E coli is a gram-negative bacillus that grows well on commonly used media. It is lactose-fermenting and beta-
hemolytic on blood agar. Most E coli strains are non-pigmented.

The image below shows Escherichia coli on Gram staining.

Note: . In Gram’s staining technique, all the isolates were pink coloured, small rod shaped Gram negative
bacilli and in the hanging drop technique they were motile.

Differential Diagnoses of E coli Infection

Note: E. coli is Indole (+), Urease (-), Motility (+), Glucose fermentation (+), Lactose fermentation (+) and sucrose
fermentation (+/-)

Cultivation

• Media of Choice

‘Lysogeny' or Luria broth (LB) is the most commonly used growth medium for E. coli. It promotes fast growth and
provides good plasmid yields, making it an excellent choice for most applications, especially small-scale plasmid preps.

Example: LB in agar plate

BIOCHEMICAL MEDIA USED IN THE DIFFERENTIATION AND ISOLATION OF E. coli

• E. coli O157:H7 causes a severe intestinal infection in humans. It is the most common strain to cause
illness in people. (John Hopkins Medicine)
• The Centers for Disease Control and Prevention (CDC) reports about 70,000 cases of this type of E.
coli infection occur in the United States each year.

Escherichia coli can be seen growing on MacConkey agar.

Note: MacConkey agar medium, colonies are bright pink due to lactose fermentation

Incubation Conditions and Duration

 24 to 48 hours @ 37oc temp.

Note: Within 24 to 48 hours, all samples were cultured primarily in nutrient broth then subcultured onto the MacConkey
agar then visible colonies of E. coli bacteria will appear in the agar plate.

For isolation, However, MacConkey agar should be incubated only in ambient air
Diagnosis

Definitive diagnosis is based on the isolation of the organism in the microbiology laboratory from clinical specimens.
Specimens may be blood, urine, sputum, stool or other fluids.

 Stool sample

Note: To diagnose illness caused by E. coli infection, a sample of your feces is sent to a laboratory to be tested for the
presence of E. coli bacteria.

Prevention

 Good hygiene
 Handwashing
 After livestock contact
 Before eating and drinking
 After changing diapers
 Don’t cross-contaminate
 Wash hands, counter, cutting boards, utensils after contact with raw meat
 Thoroughly cook meats
 Avoid unpasteurized products
 Wash fruits/vegetables before eating
 Keep livestock away from private water supplies

Treatment

 Treatment is based on symptomatology

 Fluid replacement is the primary treatment
 Antibiotics (for severe disease)